| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
346 |
342 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
65 |
64 |
$2K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
43 |
43 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
29 |
28 |
$719.64 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
19 |
19 |
$627.00 |
| 90461 |
|
92 |
88 |
$430.00 |
| 90658 |
|
67 |
65 |
$129.69 |
| 92552 |
|
103 |
103 |
$0.00 |
| 99173 |
|
75 |
75 |
$0.00 |
| 90685 |
|
14 |
14 |
$0.00 |